1225072101 NPI number — MRS. LORI K HAWKINS LPA

Table of content: MRS. LORI K HAWKINS LPA (NPI 1225072101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225072101 NPI number — MRS. LORI K HAWKINS LPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS
Provider First Name:
LORI
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225072101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2807 NEUSE BLVD
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-636-0112
Provider Business Mailing Address Fax Number:
252-634-9778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2807 NEUSE BLVD
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-636-0112
Provider Business Practice Location Address Fax Number:
252-634-9778
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1861 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6107022 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046M0 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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